Association Between Pupil Light Reflex and Delirium in Adults With Traumatic Brain Injury: Preliminary Findings.

Alexandra Lapierre, Annie Proulx, Céline Gélinas, Stéphanie Dollé, Sheila Alexander, David Williamson, Francis Bernard, Caroline Arbour
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Abstract

Abstract: BACKGROUND: Delirium is a common neurological complication in patients admitted to the intensive care unit (ICU) after moderate to severe traumatic brain injury (TBI). Although current clinical guidelines prioritize delirium prevention, no specific tool is tailored to detect early signs of delirium in TBI patients. This preliminary 2-phase observational study investigated the correlation between the pupillary light reflex (PLR), measured with a pupillometer during mechanical ventilation, and the development of postextubation delirium in TBI patients. METHODS: A convenience sample of 26 adults with moderate to severe TBI under mechanical ventilation was recruited during their ICU stay. In phase I, PLR measurements were performed in the first 3 days of ICU admission using automated infrared pupillometry. In phase II, 2 raters independently extracted delirium data in the 72 hours post extubation period from medical records. Delirium was confirmed with a documented medical diagnosis. Point-biserial correlations ( rpb ) were used to examine the association between PLR scores and the presence of postextubation delirium. Student t tests were also performed to compare mean PLR scores between patients with and without delirium. RESULTS: Ten TBI patients (38%) were diagnosed with postextubation delirium, whereas 16 (62%) were not. Significant correlations between delirium and 2 PLR variables were found: pupil constriction percentage ( rpb (24) = -0.526, P = .006) and constriction velocity ( rpb (24) = -0.485, P = .012). The t test also revealed a significant difference in constriction percentage and velocity scores between TBI patients with and without delirium ( P ≤ .01). CONCLUSION: Our findings suggest that the use of pupillometry in the first 3 days of mechanical ventilation during an ICU stay may help identify TBI patients at risk for delirium after extubation. Although further research is necessary to support its validity, this technological tool may enable ICU nurses to better screen TBI patients for delirium and prevent its development.

创伤性脑损伤成人瞳孔光反射与谵妄之间的关系:初步研究结果。
摘要:背景:谵妄是中重度创伤性脑损伤(TBI)后入住重症监护室(ICU)的患者常见的神经系统并发症。尽管目前的临床指南优先考虑预防谵妄,但没有专门的工具来检测创伤性脑损伤患者的早期谵妄症状。这项分两个阶段进行的初步观察性研究调查了机械通气期间使用瞳孔计测量的瞳孔光反射(PLR)与创伤性脑损伤患者拔管后谵妄发展之间的相关性。方法:在重症监护病房住院期间,招募了 26 名接受机械通气的中重度创伤性脑损伤成人患者。在第一阶段,使用自动红外瞳孔测量仪在患者入住重症监护室的前三天测量瞳孔回缩率。在第二阶段,两名评分员从医疗记录中独立提取拔管后 72 小时内的谵妄数据。谵妄需经有据可查的医学诊断证实。点-线性相关(rpb)用于检验 PLR 评分与拔管后谵妄存在之间的关联。还进行了学生 t 检验,以比较有谵妄和无谵妄患者的 PLR 平均得分。结果:10 名创伤性脑损伤患者(38%)被诊断为插管后谵妄,而 16 名患者(62%)未被诊断为谵妄。谵妄与两个 PLR 变量之间存在显著相关性:瞳孔收缩百分比(rpb(24) = -0.526,P = .006)和收缩速度(rpb(24) = -0.485,P = .012)。t 检验还显示,有谵妄和无谵妄的创伤性脑损伤患者在收缩百分比和收缩速度评分方面存在显著差异(P ≤ .01)。结论:我们的研究结果表明,在重症监护病房机械通气的前 3 天使用瞳孔测量法可能有助于识别拔管后有谵妄风险的 TBI 患者。尽管还需要进一步的研究来支持其有效性,但这一技术工具可使重症监护室护士更好地筛查创伤性脑损伤患者的谵妄并防止其发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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